Endoscopic Ultrasound for Early Stage Esophageal Adenocarcinoma: Implications for Staging and Survival
Background Patients often receive induction therapy based on endoscopic ultrasound (EUS)–identified nodal spread (N1) or deep tumor invasion (T3), although controversy exists regarding the role of induction therapy for early stage disease. We aim to evaluate the reliability of EUS in identifying ear...
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| creator | Crabtree, Traves D., MD Yacoub, Wael N., MD Puri, Varun, MD Azar, Riad, MD Zoole, Jennifer Bell, BSN Patterson, G. Alexander, MD Krupnick, A. Sasha, MD Kreisel, Daniel, MD, PhD Meyers, Bryan F., MD, MPH |
| description | Background Patients often receive induction therapy based on endoscopic ultrasound (EUS)–identified nodal spread (N1) or deep tumor invasion (T3), although controversy exists regarding the role of induction therapy for early stage disease. We aim to evaluate the reliability of EUS in identifying early stage disease and the subsequent impact on treatment and outcomes. Methods We retrospectively studied 149 patients who underwent EUS and esophagectomy for adenocarcinoma between January 2000 and December 2008. Computed tomography (CT) was performed in all patients, whereas positron emission tomography (PET) was performed in 91%. Clinical stage (c), pathologic stage (p), operative mortality, and survival were recorded. Results Unanticipated pathologic nodal disease was similar in patients with cT1N0 and cT2N0 tumors (6/25 [24%] versus 7/18 [38.8%]; p = 0.6). Among the 18 cases of cT2N0 disease, 9 (50%) were pathologically staged as T1N0, 8 (44%) were upstaged to pT3N0-1, and 1 (6%) was pT2N0. One case of cT1N0 tumor (4%) was upstaged to pT3N0. Among patients with cT1-2N0 tumors, 5-year disease-free survival for the group that was appropriately staged was 89.8% versus 39.9% for the group that had a higher pathologic stage than their clinical stage (ie, >T2N0) ( p |
| doi_str_mv | 10.1016/j.athoracsur.2011.01.063 |
| format | Article |
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Alexander, MD ; Krupnick, A. Sasha, MD ; Kreisel, Daniel, MD, PhD ; Meyers, Bryan F., MD, MPH</creator><creatorcontrib>Crabtree, Traves D., MD ; Yacoub, Wael N., MD ; Puri, Varun, MD ; Azar, Riad, MD ; Zoole, Jennifer Bell, BSN ; Patterson, G. Alexander, MD ; Krupnick, A. Sasha, MD ; Kreisel, Daniel, MD, PhD ; Meyers, Bryan F., MD, MPH</creatorcontrib><description>Background Patients often receive induction therapy based on endoscopic ultrasound (EUS)–identified nodal spread (N1) or deep tumor invasion (T3), although controversy exists regarding the role of induction therapy for early stage disease. We aim to evaluate the reliability of EUS in identifying early stage disease and the subsequent impact on treatment and outcomes. Methods We retrospectively studied 149 patients who underwent EUS and esophagectomy for adenocarcinoma between January 2000 and December 2008. Computed tomography (CT) was performed in all patients, whereas positron emission tomography (PET) was performed in 91%. Clinical stage (c), pathologic stage (p), operative mortality, and survival were recorded. Results Unanticipated pathologic nodal disease was similar in patients with cT1N0 and cT2N0 tumors (6/25 [24%] versus 7/18 [38.8%]; p = 0.6). Among the 18 cases of cT2N0 disease, 9 (50%) were pathologically staged as T1N0, 8 (44%) were upstaged to pT3N0-1, and 1 (6%) was pT2N0. One case of cT1N0 tumor (4%) was upstaged to pT3N0. Among patients with cT1-2N0 tumors, 5-year disease-free survival for the group that was appropriately staged was 89.8% versus 39.9% for the group that had a higher pathologic stage than their clinical stage (ie, >T2N0) ( p <0.001). Operative mortality for patients with cT1-2N0 tumors was 0/43 (0%), which was no different from that in the higher clinical stage groups with (1/37, 2.7%) or without (2/68, 2.9%) induction therapy ( p = 0.5). Multivariate analysis identified marked/intense uptake on staging PET (odds ratio, 5.76, 95%; confidence interval, 1.25 to 26.52; p = 0.021) to be a factor predictive of upstaging of cT1-2N0 tumors. Conclusions Current staging techniques are inadequate for predicting T1-2N0 disease in esophageal adenocarcinoma. Survival is excellent with operation alone in patients with tumors appropriately staged as T1-2N0, although patients with tumors upstaged to greater than T2N0 have significantly worse survival. Other preoperative factors such as PET uptake may help select patients with cT1-2N0 tumors that will be upstaged at resection.</description><identifier>ISSN: 0003-4975</identifier><identifier>EISSN: 1552-6259</identifier><identifier>DOI: 10.1016/j.athoracsur.2011.01.063</identifier><identifier>PMID: 21435632</identifier><identifier>CODEN: ATHSAK</identifier><language>eng</language><publisher>New York, NY: Elsevier Inc</publisher><subject>Adenocarcinoma - diagnostic imaging ; Adenocarcinoma - mortality ; Adenocarcinoma - pathology ; Adenocarcinoma - surgery ; Aged ; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy ; Biological and medical sciences ; Biopsy, Needle ; Cardiology. Vascular system ; Cardiothoracic Surgery ; Cohort Studies ; Confidence Intervals ; Diagnostic Imaging - methods ; Disease-Free Survival ; Endosonography - methods ; Esophageal Neoplasms - diagnostic imaging ; Esophageal Neoplasms - mortality ; Esophageal Neoplasms - pathology ; Esophageal Neoplasms - surgery ; Esophagectomy - methods ; Esophagectomy - mortality ; Esophagus ; Female ; Follow-Up Studies ; Gastroenterology. Liver. Pancreas. Abdomen ; Hospital Mortality - trends ; Humans ; Immunohistochemistry ; Male ; Medical sciences ; Middle Aged ; Multivariate Analysis ; Neoplasm Invasiveness - pathology ; Neoplasm Staging ; Odds Ratio ; Pneumology ; Positron-Emission Tomography ; Postoperative Complications - mortality ; Retrospective Studies ; Risk Assessment ; Surgery ; Survival Analysis ; Tomography, X-Ray Computed ; Treatment Outcome ; Tumors</subject><ispartof>The Annals of thoracic surgery, 2011-05, Vol.91 (5), p.1509-1516</ispartof><rights>The Society of Thoracic Surgeons</rights><rights>2011 The Society of Thoracic Surgeons</rights><rights>2015 INIST-CNRS</rights><rights>Copyright © 2011 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c458t-4509694101f3d5b3979de68a0a4924e20cb4534ac1d87a8cc2a0c33b92d2374c3</citedby><cites>FETCH-LOGICAL-c458t-4509694101f3d5b3979de68a0a4924e20cb4534ac1d87a8cc2a0c33b92d2374c3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27923,27924</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=24138128$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/21435632$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Crabtree, Traves D., MD</creatorcontrib><creatorcontrib>Yacoub, Wael N., MD</creatorcontrib><creatorcontrib>Puri, Varun, MD</creatorcontrib><creatorcontrib>Azar, Riad, MD</creatorcontrib><creatorcontrib>Zoole, Jennifer Bell, BSN</creatorcontrib><creatorcontrib>Patterson, G. Alexander, MD</creatorcontrib><creatorcontrib>Krupnick, A. Sasha, MD</creatorcontrib><creatorcontrib>Kreisel, Daniel, MD, PhD</creatorcontrib><creatorcontrib>Meyers, Bryan F., MD, MPH</creatorcontrib><title>Endoscopic Ultrasound for Early Stage Esophageal Adenocarcinoma: Implications for Staging and Survival</title><title>The Annals of thoracic surgery</title><addtitle>Ann Thorac Surg</addtitle><description>Background Patients often receive induction therapy based on endoscopic ultrasound (EUS)–identified nodal spread (N1) or deep tumor invasion (T3), although controversy exists regarding the role of induction therapy for early stage disease. We aim to evaluate the reliability of EUS in identifying early stage disease and the subsequent impact on treatment and outcomes. Methods We retrospectively studied 149 patients who underwent EUS and esophagectomy for adenocarcinoma between January 2000 and December 2008. Computed tomography (CT) was performed in all patients, whereas positron emission tomography (PET) was performed in 91%. Clinical stage (c), pathologic stage (p), operative mortality, and survival were recorded. Results Unanticipated pathologic nodal disease was similar in patients with cT1N0 and cT2N0 tumors (6/25 [24%] versus 7/18 [38.8%]; p = 0.6). Among the 18 cases of cT2N0 disease, 9 (50%) were pathologically staged as T1N0, 8 (44%) were upstaged to pT3N0-1, and 1 (6%) was pT2N0. One case of cT1N0 tumor (4%) was upstaged to pT3N0. Among patients with cT1-2N0 tumors, 5-year disease-free survival for the group that was appropriately staged was 89.8% versus 39.9% for the group that had a higher pathologic stage than their clinical stage (ie, >T2N0) ( p <0.001). Operative mortality for patients with cT1-2N0 tumors was 0/43 (0%), which was no different from that in the higher clinical stage groups with (1/37, 2.7%) or without (2/68, 2.9%) induction therapy ( p = 0.5). Multivariate analysis identified marked/intense uptake on staging PET (odds ratio, 5.76, 95%; confidence interval, 1.25 to 26.52; p = 0.021) to be a factor predictive of upstaging of cT1-2N0 tumors. Conclusions Current staging techniques are inadequate for predicting T1-2N0 disease in esophageal adenocarcinoma. Survival is excellent with operation alone in patients with tumors appropriately staged as T1-2N0, although patients with tumors upstaged to greater than T2N0 have significantly worse survival. Other preoperative factors such as PET uptake may help select patients with cT1-2N0 tumors that will be upstaged at resection.</description><subject>Adenocarcinoma - diagnostic imaging</subject><subject>Adenocarcinoma - mortality</subject><subject>Adenocarcinoma - pathology</subject><subject>Adenocarcinoma - surgery</subject><subject>Aged</subject><subject>Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy</subject><subject>Biological and medical sciences</subject><subject>Biopsy, Needle</subject><subject>Cardiology. Vascular system</subject><subject>Cardiothoracic Surgery</subject><subject>Cohort Studies</subject><subject>Confidence Intervals</subject><subject>Diagnostic Imaging - methods</subject><subject>Disease-Free Survival</subject><subject>Endosonography - methods</subject><subject>Esophageal Neoplasms - diagnostic imaging</subject><subject>Esophageal Neoplasms - mortality</subject><subject>Esophageal Neoplasms - pathology</subject><subject>Esophageal Neoplasms - surgery</subject><subject>Esophagectomy - methods</subject><subject>Esophagectomy - mortality</subject><subject>Esophagus</subject><subject>Female</subject><subject>Follow-Up Studies</subject><subject>Gastroenterology. Liver. Pancreas. Abdomen</subject><subject>Hospital Mortality - trends</subject><subject>Humans</subject><subject>Immunohistochemistry</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Multivariate Analysis</subject><subject>Neoplasm Invasiveness - pathology</subject><subject>Neoplasm Staging</subject><subject>Odds Ratio</subject><subject>Pneumology</subject><subject>Positron-Emission Tomography</subject><subject>Postoperative Complications - mortality</subject><subject>Retrospective Studies</subject><subject>Risk Assessment</subject><subject>Surgery</subject><subject>Survival Analysis</subject><subject>Tomography, X-Ray Computed</subject><subject>Treatment Outcome</subject><subject>Tumors</subject><issn>0003-4975</issn><issn>1552-6259</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2011</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqNkkuLFDEUhYMoTjv6F6Q24qraPOvhQpgZWh0YcNHOOty-lZpJm0rKpKqh_70pu3XAlXAhCfnOSXJyCSkYXTPKqg_7NUyPIQKmOa45ZWxNc1XiGVkxpXhZcdU-JytKqShlW6sL8iqlfV7yvP2SXHAmhaoEX5F-47uQMIwWi3s3RUhh9l3Rh1hsILpjsZ3gwRSbFMbHPAFXXHXGB4SI1ocBPha3w-gswmSDT791i8L6hwKyz3aOB3sA95q86MEl8-Y8XpL7z5vvN1_Lu29fbm-u7kqUqplKqWhbtTK_sRed2om2bjtTNUBBtlwaTnEnlZCArGtqaBA5UBRi1_KOi1qiuCTvT75jDD9nkyY92ITGOfAmzEk3lWSt4rLOZHMiMYaUoun1GO0A8agZ1UvIeq-fQtZLyJrmqkSWvj0fMu8G0_0V_kk1A-_OACQE10fwaNMTJ5loGG8yd33iTI7kYE3UCa3xaDobDU66C_Z_bvPpHxN01ucfcT_M0aR9mKPPkWumE9dUb5emWHqCsdwOSlDxC6VntRk</recordid><startdate>20110501</startdate><enddate>20110501</enddate><creator>Crabtree, Traves D., MD</creator><creator>Yacoub, Wael N., MD</creator><creator>Puri, Varun, MD</creator><creator>Azar, Riad, MD</creator><creator>Zoole, Jennifer Bell, BSN</creator><creator>Patterson, G. Alexander, MD</creator><creator>Krupnick, A. Sasha, MD</creator><creator>Kreisel, Daniel, MD, PhD</creator><creator>Meyers, Bryan F., MD, MPH</creator><general>Elsevier Inc</general><general>Elsevier</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20110501</creationdate><title>Endoscopic Ultrasound for Early Stage Esophageal Adenocarcinoma: Implications for Staging and Survival</title><author>Crabtree, Traves D., MD ; Yacoub, Wael N., MD ; Puri, Varun, MD ; Azar, Riad, MD ; Zoole, Jennifer Bell, BSN ; Patterson, G. Alexander, MD ; Krupnick, A. Sasha, MD ; Kreisel, Daniel, MD, PhD ; Meyers, Bryan F., MD, MPH</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c458t-4509694101f3d5b3979de68a0a4924e20cb4534ac1d87a8cc2a0c33b92d2374c3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2011</creationdate><topic>Adenocarcinoma - diagnostic imaging</topic><topic>Adenocarcinoma - mortality</topic><topic>Adenocarcinoma - pathology</topic><topic>Adenocarcinoma - surgery</topic><topic>Aged</topic><topic>Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy</topic><topic>Biological and medical sciences</topic><topic>Biopsy, Needle</topic><topic>Cardiology. Vascular system</topic><topic>Cardiothoracic Surgery</topic><topic>Cohort Studies</topic><topic>Confidence Intervals</topic><topic>Diagnostic Imaging - methods</topic><topic>Disease-Free Survival</topic><topic>Endosonography - methods</topic><topic>Esophageal Neoplasms - diagnostic imaging</topic><topic>Esophageal Neoplasms - mortality</topic><topic>Esophageal Neoplasms - pathology</topic><topic>Esophageal Neoplasms - surgery</topic><topic>Esophagectomy - methods</topic><topic>Esophagectomy - mortality</topic><topic>Esophagus</topic><topic>Female</topic><topic>Follow-Up Studies</topic><topic>Gastroenterology. Liver. Pancreas. Abdomen</topic><topic>Hospital Mortality - trends</topic><topic>Humans</topic><topic>Immunohistochemistry</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>Multivariate Analysis</topic><topic>Neoplasm Invasiveness - pathology</topic><topic>Neoplasm Staging</topic><topic>Odds Ratio</topic><topic>Pneumology</topic><topic>Positron-Emission Tomography</topic><topic>Postoperative Complications - mortality</topic><topic>Retrospective Studies</topic><topic>Risk Assessment</topic><topic>Surgery</topic><topic>Survival Analysis</topic><topic>Tomography, X-Ray Computed</topic><topic>Treatment Outcome</topic><topic>Tumors</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Crabtree, Traves D., MD</creatorcontrib><creatorcontrib>Yacoub, Wael N., MD</creatorcontrib><creatorcontrib>Puri, Varun, MD</creatorcontrib><creatorcontrib>Azar, Riad, MD</creatorcontrib><creatorcontrib>Zoole, Jennifer Bell, BSN</creatorcontrib><creatorcontrib>Patterson, G. Alexander, MD</creatorcontrib><creatorcontrib>Krupnick, A. Sasha, MD</creatorcontrib><creatorcontrib>Kreisel, Daniel, MD, PhD</creatorcontrib><creatorcontrib>Meyers, Bryan F., MD, MPH</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>The Annals of thoracic surgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Crabtree, Traves D., MD</au><au>Yacoub, Wael N., MD</au><au>Puri, Varun, MD</au><au>Azar, Riad, MD</au><au>Zoole, Jennifer Bell, BSN</au><au>Patterson, G. Alexander, MD</au><au>Krupnick, A. Sasha, MD</au><au>Kreisel, Daniel, MD, PhD</au><au>Meyers, Bryan F., MD, MPH</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Endoscopic Ultrasound for Early Stage Esophageal Adenocarcinoma: Implications for Staging and Survival</atitle><jtitle>The Annals of thoracic surgery</jtitle><addtitle>Ann Thorac Surg</addtitle><date>2011-05-01</date><risdate>2011</risdate><volume>91</volume><issue>5</issue><spage>1509</spage><epage>1516</epage><pages>1509-1516</pages><issn>0003-4975</issn><eissn>1552-6259</eissn><coden>ATHSAK</coden><abstract>Background Patients often receive induction therapy based on endoscopic ultrasound (EUS)–identified nodal spread (N1) or deep tumor invasion (T3), although controversy exists regarding the role of induction therapy for early stage disease. We aim to evaluate the reliability of EUS in identifying early stage disease and the subsequent impact on treatment and outcomes. Methods We retrospectively studied 149 patients who underwent EUS and esophagectomy for adenocarcinoma between January 2000 and December 2008. Computed tomography (CT) was performed in all patients, whereas positron emission tomography (PET) was performed in 91%. Clinical stage (c), pathologic stage (p), operative mortality, and survival were recorded. Results Unanticipated pathologic nodal disease was similar in patients with cT1N0 and cT2N0 tumors (6/25 [24%] versus 7/18 [38.8%]; p = 0.6). Among the 18 cases of cT2N0 disease, 9 (50%) were pathologically staged as T1N0, 8 (44%) were upstaged to pT3N0-1, and 1 (6%) was pT2N0. One case of cT1N0 tumor (4%) was upstaged to pT3N0. Among patients with cT1-2N0 tumors, 5-year disease-free survival for the group that was appropriately staged was 89.8% versus 39.9% for the group that had a higher pathologic stage than their clinical stage (ie, >T2N0) ( p <0.001). Operative mortality for patients with cT1-2N0 tumors was 0/43 (0%), which was no different from that in the higher clinical stage groups with (1/37, 2.7%) or without (2/68, 2.9%) induction therapy ( p = 0.5). Multivariate analysis identified marked/intense uptake on staging PET (odds ratio, 5.76, 95%; confidence interval, 1.25 to 26.52; p = 0.021) to be a factor predictive of upstaging of cT1-2N0 tumors. Conclusions Current staging techniques are inadequate for predicting T1-2N0 disease in esophageal adenocarcinoma. Survival is excellent with operation alone in patients with tumors appropriately staged as T1-2N0, although patients with tumors upstaged to greater than T2N0 have significantly worse survival. Other preoperative factors such as PET uptake may help select patients with cT1-2N0 tumors that will be upstaged at resection.</abstract><cop>New York, NY</cop><pub>Elsevier Inc</pub><pmid>21435632</pmid><doi>10.1016/j.athoracsur.2011.01.063</doi><tpages>8</tpages></addata></record> |
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| subjects | Adenocarcinoma - diagnostic imaging Adenocarcinoma - mortality Adenocarcinoma - pathology Adenocarcinoma - surgery Aged Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy Biological and medical sciences Biopsy, Needle Cardiology. Vascular system Cardiothoracic Surgery Cohort Studies Confidence Intervals Diagnostic Imaging - methods Disease-Free Survival Endosonography - methods Esophageal Neoplasms - diagnostic imaging Esophageal Neoplasms - mortality Esophageal Neoplasms - pathology Esophageal Neoplasms - surgery Esophagectomy - methods Esophagectomy - mortality Esophagus Female Follow-Up Studies Gastroenterology. Liver. Pancreas. Abdomen Hospital Mortality - trends Humans Immunohistochemistry Male Medical sciences Middle Aged Multivariate Analysis Neoplasm Invasiveness - pathology Neoplasm Staging Odds Ratio Pneumology Positron-Emission Tomography Postoperative Complications - mortality Retrospective Studies Risk Assessment Surgery Survival Analysis Tomography, X-Ray Computed Treatment Outcome Tumors |
| title | Endoscopic Ultrasound for Early Stage Esophageal Adenocarcinoma: Implications for Staging and Survival |
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